I am a plastic surgeon in Little Rock, AR. I used to "suture for a living", I continue "to live to sew". These days most of my sewing is piecing quilts. I love the patterns and interplay of the fabric color. I would like to explore writing about medical/surgical topics as well as sewing/quilting topics. I will do my best to make sure both are represented accurately as I share with both colleagues and the general public.

Quilts of Valor

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Monday, December 28, 2009

Just finished reading a CME article on “Aesthetic Surgery of the Face and Neck” in the Nov/Dec issue of the Aesthetic Surgery Journal (the first article referenced below). Nice review article, but I want to just concentrate on the section on smoking. This is the time of year when many resolutions are made, and often to quit smoking is one of them.

One of the major things to avoid pre- and post-facial surgery is smoking. The other major one is platelet inhibitors (ie aspirin, NSAIDs, and certain herbals).

The logic for smoking avoidance is because “tobacco smoke is an aerosol of particulate matter, volatile acids and gases. The overall cellular effect of these inhaled or absorbed byproducts is to produce an environment of relative tissue hypoxia, and delayed wound healing mediated by vasoconstriction, abnormal cellular function, and thrombogenesis.” [second reference]

The reported incidence of facelift skin flap necrosis is 12.5 times greater in smoker than nonsmokers. This risk is too high for elective surgery, so no surgeon will knowingly operate on the face of a smoker electively.

Even smoking one cigarette has been shown to cause temporary vascular spasm which can last up to one hours. This vascular spasm can result in 24-42% decrease in blood flow. This can lead to skin necrosis, poor wound healing, and increase infection.

The current recommendation for elective facial surgery is smokers is patients remain nicotine-free for four weeks before surgery and for four weeks after surgery.

Patients often underreport their smoking. To “test” their truthfulness, a salivary rapid test (NicAlert) has been developed which test for cotinine, the metabolic breakdown product of nicotine.

I would encourage all smokers to quit just for general health benefits. Keep trying. If one method doesn’t work for you, work with your primary care physician to find one that does.

You can always tell a smoker by that gray undertone to the skin. Interesting about the rapid test, hadn't heard of that one. Funny when they reek of smoke (can't smoke in the car and still smell fresh) and still deny it. Aroma so powerful I have to abandon the exam room for an hour or two lest my next patients think it's me that's the puffer!

Disclaimer

My purpose in writing my blog is to attempt to provide good solid medical information on topics of my choosing. It is a way to educate myself, my colleagues, and the general public. References will be provided on medical posts, but not on opinion essays or poetry posts. An additional purpose is to share my interest in quilting topics, a way to show my human side.

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In early 2009 I joined the Better Health Network. As part of that Network, I will occasionally be paid for my writing. Those posts will be clearly noted. I will strive to maintain my high ethical standards. If I add any advertising, it will be clearly marked as such.

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